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Predictive value of bronchoscopy after infant cardiac surgery: a prospective study

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Abstract

Background and aims

Airway evaluation following infant cardiac surgery often reveals evidence of tracheobronchial narrowing. We studied the association between airway narrowing and extubation failure (EF) in this population.

Methods

Prospective cohort study of infants (age ≤6 months) from March–September 2009. Flexible bronchoscopy (FB) evaluations were obtained using a standardised protocol after operative intervention. The primary endpoint was the development of extubation failure (EF; defined as the need for invasive mechanical ventilation ≤48 h after primary extubation) and several secondary endpoints.

Results

Fifty-three patients were evaluated at a median age of 81 [interquartile range (IQR) 13–164] days and weight of 4.2 (IQR 3.2–6.0) kg; 13 (25 %) of the patients had single ventricle palliations and two subsequently underwent heart transplantation. Significant airway narrowing was noted in 15 of 30 [50 %, 95 % confidence interval (CI) 31–69 %] patients who underwent FB; ten of the 53 patients (19 %, 95 %CI 10–32 %) subsequently developed EF. Narrowed airway calibre on bronchoscopy had a sensitivity and specificity of 50 % (95 %CI 28–71 %) and 50 % (95 %CI 28–71 %), respectively, for EF. The single greatest predictor of EF by univariate analysis was the need for preoperative ventilation [odds ratio (OR) 6.5, 95 %CI 1.3–33.2, p = 0.03]. Patients with EF had a greater likelihood of intensive care readmission (OR 4.8, 95 %CI 1.1–21, p < 0.04) during the same hospital admission.

Conclusions

Airway narrowing on FB is noted frequently after infant cardiac surgery. Overall assessment and presence of narrowing on bronchoscopy had poor sensitivity and specificity for EF in our cohort. Expert assessment of tracheobronchial narrowing on FB has poor to moderate inter-rater reliability.

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Acknowledgment

The authors would like to acknowledge the invaluable assistance of the Respiratory Therapists in the Critical Care Unit at The Hospital For Sick Children during the conduct of this study.

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Authors and Affiliations

  1. Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada

    P. P. Nayak, J. Sheth, P. N. Cox, L. Davidson, S. M. Schwartz & V. B. Sivarajan

  2. Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada

    V. Forte & G. S. Van Arsdell

  3. The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada

    C. Manlhiot, B. W. McCrindle, S. M. Schwartz & G. S. Van Arsdell

  4. Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada

    M. Solomon

  5. Division of Cardiac Critical Care, Department of Critical Care Medicine, The Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    V. B. Sivarajan

Authors
  1. P. P. Nayak
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  2. J. Sheth
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  3. P. N. Cox
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  4. L. Davidson
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  5. V. Forte
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  6. C. Manlhiot
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  7. B. W. McCrindle
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  8. S. M. Schwartz
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  9. M. Solomon
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  10. G. S. Van Arsdell
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  11. V. B. Sivarajan
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Corresponding author

Correspondence to V. B. Sivarajan.

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Nayak, P.P., Sheth, J., Cox, P.N. et al. Predictive value of bronchoscopy after infant cardiac surgery: a prospective study. Intensive Care Med 38, 1851–1857 (2012). https://doi.org/10.1007/s00134-012-2702-1

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  • DOI: https://doi.org/10.1007/s00134-012-2702-1

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